本文選題：胰十二指腸切除術(shù) + 胰瘺��； 參考：《浙江大學(xué)》2015年博士論文

【摘要】：目的 胰腺癌早期沒(méi)有明顯的臨床癥狀,不易發(fā)現(xiàn),且胰腺癌病程進(jìn)展快,臨床上確診是往往已是中晚期,手術(shù)難以完全切除,術(shù)后預(yù)后較差。胰十二指腸切除術(shù)(pancreaticoduodenectomy, PD)是目前胰腺癌的主要治療手段,關(guān)于胰腸吻合方式與術(shù)后并發(fā)癥的研究,目前相關(guān)文獻(xiàn)報(bào)道多為單中心回顧性研究,前瞻性研究都是多中心的,手術(shù)者的技術(shù)水平對(duì)研究結(jié)果有一定的偏倚影響,難以評(píng)價(jià)不同手術(shù)方式的優(yōu)劣。本論文旨在通過(guò)單中心的前瞻性的研究,比較套入式和胰管-粘膜吻合方式對(duì)PD術(shù)后并發(fā)癥的影響。 方法 研究入組對(duì)象為2012年10月2015年3月期間所有因胰腺癌、膽管癌和壺腹癌等于浙江大學(xué)醫(yī)院附屬第二醫(yī)院行胰十二指腸切除術(shù)的患者,由同一醫(yī)療小組(浙二外五病區(qū))同一主刀醫(yī)生主刀行胰十二指腸切除術(shù)治療,主要研究終點(diǎn)：胰瘺,其發(fā)生和等級(jí)標(biāo)準(zhǔn)按照國(guó)際胰瘺研究小組ISGPF標(biāo)準(zhǔn),次要研究終點(diǎn)：圍手術(shù)期死亡、并發(fā)癥、再手術(shù)、術(shù)后住院日、再入院。本研究還對(duì)胰瘺的風(fēng)險(xiǎn)因素進(jìn)行了探索。 結(jié)果 共納入患者132例,采用胰腺-空腸套入式吻合68例(套入組),采用胰管-空腸黏膜吻合64例(胰管-粘膜組)。圍手術(shù)期套入組死亡1人,胰管-粘膜組無(wú)死亡,P=1.000,術(shù)后總體并發(fā)癥發(fā)生率為51.5%,兩組并發(fā)癥的發(fā)生概率分別為55.9%vs46%,P=0.301。套入組的并發(fā)癥嚴(yán)重程度明顯高于胰管-粘膜組(Ⅲ級(jí)以上并發(fā)癥：P=0.013)。總體術(shù)后胰瘺發(fā)生率為29.5%,臨床相關(guān)性胰瘺(CR-PF)發(fā)生率為10.6%,套入組與胰管-粘膜組術(shù)后胰瘺發(fā)生率分別為30.9%vs.28.5%,P=0.729,但兩種在胰瘺等級(jí)分布上有顯著差異(P=0.004),套入組CR-PF多。中值術(shù)后住院天數(shù)分別為15天、13天(P=0.021),套入組的住院時(shí)間更長(zhǎng)。胰腺質(zhì)地硬的患者PF發(fā)生率低(P=0.013)。胰管直徑,病理類(lèi)型及性別是PF獨(dú)立的風(fēng)險(xiǎn)因素。結(jié)論 胰管對(duì)空腸套入式吻合和胰管-粘膜吻合方式相比,術(shù)后并發(fā)癥發(fā)生的概率并沒(méi)有明顯的差異。套入式吻合比胰管-粘膜吻合的術(shù)后并發(fā)癥更嚴(yán)重,且術(shù)后住院時(shí)間更長(zhǎng)。
[Abstract]:Purpose There are no obvious clinical symptoms in early stage of pancreatic cancer, which are difficult to find, and the course of pancreatic cancer is rapid, the diagnosis is usually in the middle and late stage, the operation is difficult to be completely resected, and the prognosis is poor. Pancreaticoduodenectomy (PDD) is the main treatment for pancreatic cancer at present. The study of pancreaticojejunostomy and postoperative complications is mostly monocentric and prospective studies. The technical level of the patients has a certain bias to the results of the study, it is difficult to evaluate the advantages and disadvantages of different surgical methods. The purpose of this study was to compare the effects of intra-and pancreatic duct-mucosal anastomosis on the postoperative complications of PD by a single-center prospective study. Method The study included all patients with pancreatic cancer, cholangiocarcinoma and ampullary carcinoma who underwent pancreaticoduodenectomy in the second affiliated Hospital of Zhejiang University Hospital during October 2012 and March 2015. Pancreaticoduodenectomy was performed by the same medical team (Zhejiang No. 2, No. 5) and the same surgeon. The main endpoints were: pancreatic fistula. The occurrence and grade of pancreatic fistula were according to the ISGPF standard of international pancreatic fistula research group. Secondary study endpoint: perioperative death, complications, re-operation, postoperative hospitalization, re-admission. The risk factors of pancreatic fistula were also explored. Result A total of 132 patients were included in this study. 68 cases were treated with pancreaticojejunostomy and 64 cases with pancreatic duct-jejunal mucosal anastomosis (pancreaticojejunostomy). One patient died in the perioperative period and there was no death in the pancreatic duct mucosa group. The overall incidence of postoperative complications was 51.5. The probability of complications in the two groups was 55.9 vs 46 and P 0.301 respectively. The severity of complications in the intratuminal group was significantly higher than that in the pancreatic duct-mucosal group (> grade 鈪，

本文編號(hào)：1887201